Trans men are people who were assigned female at birth but whose gender identity is male. They may be transgender, cisgender or nonbinary and have any sexual orientation.
HIV risk among trans men is under-researched, especially in Africa where these men are vulnerable and engage in sex work. We conducted a multi-method study to characterize HIV/STI risk among trans men in Uganda.
Hormone Replacement Therapy (HRT)
Many trans men want to use hormone therapy (HRT) to change their body to better align with their gender identity. Masculinizing HRT is used to increase testosterone levels and suppress female secondary sex characteristics.
Hormone therapy can be tailored to a patient’s transition goals, but must also take into account their medical comorbidities and the risks associated with hormone use. It is important for providers to discuss this treatment with their patients to ensure that they understand all the risks and benefits.
OHSU provides a variety of primary care services for transgender patients, which include the prescribing and monitoring of hormone therapy. Our primary care physicians will tailor your hormone therapy to your individual needs.
Using hormones can cause significant physical and emotional changes, which can lead to stress and other health issues. It is important to have a support system and talk to your doctor about the emotional impacts of hormone therapy.
Gynecological Care
Trans men are an underserved population, and obstetrician-gynecologists need to be aware of their unique health care needs and provide them with inclusive, thoughtful, and affirming care.
Moreover, transgender individuals who are planning to have children should discuss their desired fertility and parenting options before transitioning. Fertility preservation options for transgender individuals include sperm banking, oocyte storage, embryo storage, and ovarian or testicular cryopreservation.
Obstetrician-gynecologists should provide transgender patients with information about the benefits and risks of fertility preservation, including endometrial cancer risk, and offer oocyte or embryo cryopreservation if appropriate. Similarly, contraceptive counseling should be provided prior to initiation of hormone therapy to facilitate reproductive goal attainment.
To understand the barriers to gynecologic care for transgender men, a qualitative investigation was conducted. Face-to-face interviews were conducted with six self-identified transgender men between the ages of 19 and 45 years in private locations chosen by each participant (i.e., the participant’s home or a shared interview room at one of the research health centers). The interviews focused on barriers to receiving gynecologic care.
Sexual Settings
There are many sexual settings that trans men can engage in, depending on their preferences. This includes sex with other people, as well as sexual activity using prosthetic genitals, toys, or fingers. Often, they will use condoms or other barriers to prevent HIV-related risk from occurring.
There is no evidence that these activities are associated with high HIV-related risk. In fact, they may be a more common occurrence than many of us might think.
These findings suggest that heterosexual men may have the capacity to experience some sexual interest in feminine trans individuals. This may be influenced by socio-cultural factors, including exposure to transgender images, past experiences, and beliefs about sexuality.
The present study relied on a convenience sample of Canadian undergraduate men, who were predominantly enrolled in psychology courses. Although they may have exhibited higher levels of self-selection bias than those who did not volunteer, they did not have any psychosocial factors that might have inhibited their ability to show sexual interest in feminine trans individuals.
Childbearing
Pregnancy is a life-changing experience for any individual. But it can be particularly challenging for trans men, who face a variety of social and medical barriers that make pregnancy difficult.
As a result, many trans men and gender nonconforming individuals choose to avoid becoming pregnant or trying to conceive. Alternatively, they may attempt to conceive through assisted reproductive technology (AST), such as sperm freezing or a surrogate.
While these procedures are often a positive choice, there are several concerns about their safety and impact on future fertility, pregnancy, and child health for trans men and women. For example, testosterone may interfere with ovarian stimulation and lead to hypertension, preterm labor, placental interruption, and anemia.
Additionally, some providers may not have received training on caring for transgender patients during pregnancy or birth. This lack of knowledge can lead to inaccurate diagnoses, misdiagnoses, and poor or delayed care during pregnancy for transgender men.